Heart disease in pregnancy has an incidence of 0.2%-0.4%, and is the most
frequent cause of maternal death in developed countries 1,2
,Cardiac disease in the pregnant patient can present challenges
in cardiovascular and maternal-fetal management.Since pregnancy carries
dramatic physiologic changes upon the cardiovascular system even in normal
women,these changes ( Tab 1 ) begin in the first 5 to 8 weeks of gestation and peak
late in the second trimester. Blood volume increases 40% to 50% during normal
pregnancy also cardiac output rises 30% to 50% above baseline, peaking at the end of
the second trimester and reaching a plateau until delivery. In cardiac patients the
decompensation often coincides with this peak. Pregnancy is a hypercoagulable
status in which pregnant women are susceptible to arterial thromboembolism 3
to 4 times more likely to have, and 4 to5 times more likely to have venous
thromboembolism as compared with nonpregnant women.Hypercoagulable status  increases the incidence of mechanical
valve thrombosis from 7 to 23%,half of these cases are Mitral valve cases3 .

With the increasing the number of patients with prosthetic valves, there aremore pregnant
ladies with prosthetic valves , in spite of the fact that asymptomatic ladies with
prosthetic valves tolerate the pregnancy 4,however, the complications due to the use
of anticoagulant treatment during pregnancy make the use of biological
valves is superior than the mechanical one 3,5In the developing countries, rheumatic
heart disease (RHD) is the most common cardiac disease in pregnantwomen, and the
most important cause of maternal death6,7.Moderate to severe mitral valve
stenosis cases in particular is a high-risk8 ,in 2007 ESC launched an
internationalRegistry On Pregnancy and Cardiac Disease (ROPAC) 9,10,

whichshowed significant difference between developed and developing countrie